Predicting the need for intraoperative cholangiography after cholecystectomy.

A decision tree based on the common clinical indicators seen in acute and chronic cholecystitis is presented. The use of such a decision tree aids in the selective, rather than the routine, use of intraoperative cholangiography. In this series, the number of intraoperative cholangiograms could have been decreased from 275 to 101 by using the decision tree. At the same time, the number of negative explorations could have been reduced from 13 to 7, while the number of positive explorations would remain the same. The decision tree provides a systematic approach to the use of intraoperative cholangiography, thereby saving operating time and cost. By using this approach, the surgeon can not only select those patients in whom intraoperative cholangiogram will be useful in determining the need for exploration of the common duct and finding the unexpected common duct stone, but also eliminate [corrected] its use in those patients who have no clinical indications.